18 October 2011 3:34 PM

Irretrievable breakdown may best lead to divorce

In any relationship - personal or professional - there needs to be time for reassessment. As each person grows and changes, the relationship needs to grow and change.

GPs are being castigated for taking patients off their list when they complain.

Consider the alternative: keeping a patient when you know that the bond of professional and personal trust has been broken. Each and every consultation will be beset with nagging doubts on what will happen next.

That is not a confident base for taking decisions that may affect people's lives.

In the private sector there is a free market. Patients go where they choose. Fully private doctors have to work hard to keep their patients in the face of direct competition from other private doctors.

The three essential 'As' of private practice are therefore Availability, Affability and Ability. NHS doctors have few such requirements for their financial survival.

In the sixteen years in which I worked full time in the NHS I received no complaints. The only time I ever took patients off my list was on the one occasion when the Health Authority told me that I had more than the permitted 3,500 patients per doctor.

I was told that patients would be taken off my list at random. I should have gone with that because subsequently I got all the blame when I took off those who gave me no pleasure. I recall that one was an English ambassador, home on leave. I did not like being treated as one of his flunkies.

We should remember that there are restrictions to doctors removing patients from their list when there is no local alternative.

We should also remember that Health Authorities have the power to allocate patients to doctors, whether they want them or not.

In my work as a fully private doctor, I received the same occasional complaints that any private doctor receives - sometimes, it seemed to me, when the patient wanted to get out of paying a bill.

In my work as an addiction specialist, helping people to come off alcohol and drugs and other addictive substances and behaviours, I received - and still do receive - complaints all the time.

Getting between patients and their various 'drugs' does not make me popular initially. Nor does showing families that their ways of trying to help addicts do not work in practice.

In my addiction work, I am hated or adored. That goes with the job. Neither influences me. I have a job to do.

However, I do have personal experience of looking after extremely demanding patients. I therefore know how some GPs are treated by angry patients.

I myself see the anger as possible evidence of something I have done wrong or as something that goes with this particular clinical territory.

I do not retaliate. I don't want a medal for that. I still choose to be in this kitchen and I can take the heat.

One man believes that I, together with the KGB, was involved in the murder of his sister and his aunt.

Another man, whom I saw twice, believes that I was responsible for his divorce - and the distress caused to his child - when I did not take his side against his wife, whom I had never met.

A third blames me for damaging his daughter by calling her alcoholic - which I never do: I leave patients to make their own diagnosis.

A lady declared in a public meeting that she could never forgive herself if she failed to take the opportunity to tell everyone that I had destroyed her marriage by telling her husband to have an affair. Clearly I could have done no such thing - but there would be no point in arguing with her.

A young man said that I was trying to kill him by taking him off drugs - slowly - and that he would kill me first.

Two patients have separately tried to destroy me professionally by telling complete lies.

That's just the way it is in my line of work, I make no complaint about any of these patients or family members. I would offer them my help again if they asked for it.

I am no saint: I'm a professional. Other professionals have similar challenges.

However, all these patients must have GPs somewhere and I would not blame those doctors at all if they said that enough is enough.

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DR ROBERT LEFEVER

Dr Robert Lefever established the very first addiction treatment centre in the UK that offered rehabilitation to eating disorder patients, as well as to those with alcohol or drug problems. He was also the first to treat compulsive gambling, nicotine addiction and workaholism.
He identified 'Compulsive Helping', when people do too much for others and too little for themselves, as an addictive behaviour and he pioneered its treatment.
He has worked with over 5,000 addicts and their families in the last 25 years and, until recently, ran a busy private medical practice in South Kensington.
He has written twenty six books on various aspects of depressive illness and addictive behaviour.
He now provides intensive private one-to-one care for individuals and their families.

He has written twenty six books on various aspects of depressive illness and addictive behaviour.

He now uses his considerable experience to provide intensive private one-to-one care for individuals and their families.